Forums General Chronic IT band/quad TIGHTNESS and knee pain (chondromalacia patella?) for 6 years! Re: Chronic IT band/quad TIGHTNESS and knee pain (chondromalacia patella?) for 6 years!

AvatarSarah Thompson

I have not read the entire thread, but so far I have the basics about your runners knee/ITBS/leg length discrepancy.

I am a massage therapist with athletic experience as a professional modern dancer. I primarily use deep tissue, neuromuscular, and assisted isolated stretching techniques and specialize in diaphragmatic disorders, pelvic function (sacroiliac joint disfunction, piriformis syndrome), cervical spine, and TMJ.

First, I would like to address the “hip flexor”, which is the iliopsoas (or illiacus plus psoas major). It should not be considered part of the quadriceps. Many therapists are of that perspective, but I whole heartedly disagree.

Your iliopsoas is better seen as part of the diaphragm. Where one ends the other nearly seamlessly begins.

Diaphragmatic disorders can most commonly result in sacroiliac joint disfunction, thoracic outlet syndrome, piriformis syndrome, ITBD, pain throughout the hips, low back, spine, and ribcage. The reasoning behind why the diaphragm should be considered part of a whole body system of its own, instead of a piece of the muscular system, takes an entire paper to explain, but that concept is very important. 

I saw many times repeated by folks here, “It’s like you’re missing the problem”, “the work I’m doing in my glutes, quads, etc… …only last for a little while before everything tightens back up”, “my foot tracks to the outside”, “my hips are rotating laterally and anteriorly”, “try to do the exercises in a way that does not activate your hip flexor”, “I do tend to slouch when sitting”.

An illustration:

The psoas connects on the lesser trochanter where some of the adductors attach. Tightness in the psoas will result in tipping the bowl of the pelvis forward to the trochanter, straining hamstrings, glutes, and rotating the femur so that the lesser trochanter presents forward and your toes point outward, which allows tightening in all of the deep hip rotators and glutes. Your upper chest will droop/slouch forward as it is pulled down by the psoas/diaphragm tightness.

Your psoas will tighten if you are chest breathing instead of breathing into the belly, stretching the transverse abdominis, and using the transverse ab. to compress the abdomen. The nerves which innervate the diaphragm will only activate and tell it to reset to its umbrella-like position if breathing is done correctly. Babies naturally belly breathe only. We learn to chest breathe in response to our need for fight or flight. The chest space opens to allow for more air, but if we do not return to the diaphragmatic breath (thanks to modern anxiety, stress, and sitting for too long), the transverse abdominis weakens, the diaphragm tips upward, cascading a shortness into the psoas which will in turn rotate and shorten the leg (usually left side, since the right side of the diaphragm has a 3lb liver holding it in place).

What I recommend:

Find a massage therapist who knows neuromuscular therapy and can release your diaphragm, your psoas major, and the illiacus. You can somewhat get at the illiacus on your own by touching the front of the hip (where it begins to point forward) and keeping your thumb on the bone slide down toward your spine so that you pinch the illiacus between your thumb and the interior of the hip bowl. However, it is better and safer to let an experienced practitioner release it for you to avoid organ and blood vessel trauma and the diaphragm release cannot be done on your own at all.

Then find a PT who knows diaphragmatic strengthening exercises (may come as part of sacroiliac joint disfunction treatment or not). These exercises should include having you lay on your back, feet on a wall at 90 degrees, activating your hamstrings, and inflating a balloon using belly A.K.A. diaphragmatic breathing.

You can smash the parts that hurt all you want, but if the pain you feel is a symptom instead of the source (likely), you will never improve for long. You may or may not have a leg length discrepancy. That is either caused by a diaphragmatic disorder or is exasperating and increasing the problem. I suggest wearing the taller heel wedge and getting the work I recommended for your diaphragm done. If things begin to clear up, try weaning off the heel wedge to see if symptoms return.
Also, stretch your psoas major.